Permit ';' CITY ®� TIGAR® FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00079
TTGAR'D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2010
Parcel: 2S 113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description: Relocate (6) heads and relocate (3) heads.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 07/28/2010 $64.54
PORTLAND, OR 97224 12% State Surcharge - Building 07/28/2010 $7.74
PHONE: 503 - 624 -6300
Contractor:
PACIFIC FIRE SYSTEMS LLC
6704 RIVERIA CT
WEST LINN, OR 97068
PHONE: 503 - 710 -6646
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $72.28
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Not -: • - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir: questions to OU . by c. ' 503.246.6699 or 1.800.332.2344.
Iss ed By: / / le/ • / 9 Permittee Signature: A .
Cali 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
r�
Fire Protection Systems ij • " Received � ,
City of Tigard JUL n DateB : 7 /�6 �O _ Permit No.: +� g�(b_+ MO
II
13125 SW Hall Blvd., Tigard, OR 97223 �J a �� io Plan Review Q�
C B Phone: 503.639.4171 Fax: 503.598.1960 Date : Other Permit: b p010lQ v co /f /l
CITY Line: 503.639.4175
Inspection ` ! s n T Date Ready/By: 3 uris: H See Page 2 for
i it:i��ltt1 P EP�' r?�,, Cy l�
Internet: l.11t_11,I1}�, DIVIS�Oi'J
www.tigard- or.gov BUILDING Notified/Method: Supplemental Information
TYPE OF WORK' ' . REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling mmerciai /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: k to to 4 -7 ,_3 New dwelling area: square feet
City /State /ZIP: - (-a,. :1C-• OZ, Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: ,Yp 5krk ""re Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
• REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
. DESCRIPTION OF WORK • - ., work indicated on this application.
`�— a -4 �Ae - -1 fin, iu i.1n� Valuation: S l`� "DO
� � �,r 7 � car � ,1�. `z to z E Existing building area: square feet
17 --- 1 --- • -- 2-4))e-e e New building area: square feet
' ❑ PROPERTY OWNER • D, TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
• ❑ ' APPLICANT •`' -. ❑ CONTACT • PERSON - " • NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: - jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) Fax::( )
E -mail:
'CONTRACTOR : BUILDING: PERMIT FEES*
Business name: �� � �, F Z t ;� S 5 � m,, (Please.ejer fe e: !
7 Pe rmit fee: 6v. 5y
Address: L., "lo 4- 7---N J I. ', jcA c—
City /State /ZIP: Ec J Y (_,,1 n}3 <5) R. �� b c- f� State surcharge (12 % of permit fee): 7 7 4
FLS plan review (40% of permit fee):
Phone: (5c 3) ,,0 1 442,'2_. Fax: ( ) (Due upon application.)
CCB lic.: L Cibt) 1 Total permit fees:
4 Amount received: -7,, aQ
<
Authorized signature: ��l
This permit application expires if a permit is not obtained
Print name: (C r m >�YEi ri . tQ Date: 1 Z •-r) within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
1:\ Building \Permits\FPS- PermitApp.doc 10/01/09 440- 4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type. I - Hood Fire Suppression System
Hood Project Valuation: $
C.) `Fire `Alarm .:
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire. Protection Permit Fees,
Project valuation subtotal (see A, B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
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